Experiences of researchers fulfilling VHA’s “fourth mission” during the COVID-19 pandemic.
Authors: Kenneth Csehak, Alexander Michael Barbaro, Stefanie D. Roman, Scott Sherman, Danil V. Makarov, Sahnah Lim, Daniel Jacob Becker
Journal: Journal of Clinical Oncology (2022)

11059 Background: As the largest integrated healthcare system in the US, the Veterans Health Administration (VHA) is chartered “to serve as the primary backup for any health care services needed...in the event of war or national emergency” according to a 1982 Congressional Act. This mission was invoked during the COVID 19 pandemic to divert clinical and research resources, resulting in dramatic changes in the activities of investigators and research staff. This study uses established behavioral change frameworks to examine the experience of VHA cancer researchers during the pandemic. Methods: We conducted a mixed methods study on the effects of the pandemic on VHA researchers. We used an electronic questionnaire composed of Likert scale statements and open-ended questions, which was constructed using the 14 domains of the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation (COM-B) model for behavior change. Likert scale statements were quantified and content analysis was performed on open ended responses. Results: The questionnaire was distributed electronically to 118 researchers participating in national VHA collaborations, with 42 responses (36%). Several significant themes and findings emerged. Only 36% of respondents did not feel that their research focus changed during the pandemic. (TDF: professional role and identity maps to COM-B Motivation). And 81% of respondents reported a diverse range of research interests (COM-B: M). Only 11 of 42 respondents (26%) reported prior experience with infectious disease research (TDF: skills maps to COM-B: C), and 31 of 42 (74%) agreed that they gained new research skills during the pandemic (COM-B: C). When asked to describe support structures helpful during the pandemic, 29% mentioned local supervisors, mentors and research staff (COM-B: C, M), 15% cited larger VHA organizations (COM-B: C) and 18% mentioned remote work abilities or telehealth (COM-B: O). Lack of timely communication from supervisors and remote work, particularly for individuals with caregiving responsibilities, were seen as limiting factors for research during the pandemic (COM-B: O). Although 83% of respondents agreed that they will be prepared to respond to future crises after COVID (COM-B: C), fewer than half (40%) of respondents felt professionally rewarded for pursuing research related to COVID, with 50% feeling neutral (COM-B: M). Conclusions: This study demonstrated the tremendous effects of the COVID 19 pandemic on research activities of VHA investigators. We identified perceptions of insufficient recognition and lack of professional advancement related to pandemic era research. Improving the structure of remote work and team communication represent high yield areas for improvement. It is essential to understand barriers and facilitators of crisis redeployment in the VHA, to make the transition effective and fulfilling for those carrying out the mission.